title: Understanding the link between leadership style, employee satisfaction, and absenteeism: a mixed methods design study in a mental health care institution.
abstract: BACKGROUND
  In service oriented industries, such as the health care sector, leadership styles have been suggested to influence employee satisfaction as well as outcomes in terms of service delivery. However, how this influence comes into effect has not been widely explored. Absenteeism may be a factor in this association; however, no studies are available on this subject in the mental health care setting, although this setting has been under a lot of strain lately to provide their services at lower costs. This may have an impact on employers, employees, and the delivery of services, and absenteeism due to illness of employees tends to already be rather high in this particular industry. This study explores the association between leadership style, absenteeism, and employee satisfaction in a stressful work environment, namely a post-merger specialty mental health care institution (MHCI) in a country where MHCIs are under governmental pressure to lower their costs (The Netherlands).
  
  
  METHODS
  We used a mixed methods design with quantitative as well as qualitative research to explore the association between leadership style, sickness absence rates, and employee satisfaction levels in a specialty MHCI. In depth, semi-structured interviews were conducted with ten key informants and triangulated with documented research and a contrast between four departments provided by a factor analysis of the data from the employee satisfaction surveys and sickness rates. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software.
  
  
  RESULTS
  Quantitative analysis revealed sickness rates of 5.7% in 2010, which is slightly higher than the 5.2% average national sickness rate in The Netherlands in 2010. A general pattern of association between low employee satisfaction, high sickness rates, and transactional leadership style in contrast to transformational leadership style was established. The association could be described best by: (1) communication between the manager and employees; (2) the application of sickness protocols by the managers; and (3) leadership style of the manager.
  
  
  CONCLUSIONS
  We conclude that the transformational leadership style is best suited for attaining employee satisfaction, for adequate handling of sickness protocols, and for lower absenteeism, in a post-merger specialty mental health setting.
authors.affiliation: Management of Cultural Diversity, Tilburg University, Tilburg, The Netherlands.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Elshout
authors.forename: Evelien
authors.initials: E
authors.lastname: Scherp
authors.forename: Christina M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
keywords: absenteeism; employee satisfaction; leadership style; qualitative research; sickness rates; specialty mental health care institution; transformational leadership